oihfedfhorigiojisdeffandomcom-20200214-history
Rfehtnhn
Doctors and nurses eat this kind of thing up and put it on shiny plaques that go on the walls of the hospital. (I suggest a wall near the gastroenterology unit, to expedite care for people who start vomiting.) Wittgenstein said that “if anyone ever wrote a book of ethics, that really was a book of ethics, it would destroy all the other books in the world with a bang.” I’m not really sure what he meant. But if anyone ever wrote a book of hospital poetry, that really was a book of hospital poetry…well, I don’t know what would happen, but I bet it would be loud and angry, and that it wouldn’t be put on shiny plaques on anybody’s walls, except maybe the same people who hang Hieronymous Bosch paintings on their walls. Wait, am I calling hospitals hellish? Sure am. It has nothing to do with the decor, which has actually gotten much nicer in your newer hospitals until it’s hard to tell them apart from a stylish office building. It’s nothing to do with the staff, either – most doctors and some nurses seem pretty happy and trade banter around the water coolers like everyone else. It’s mostly the screams. The screams are coming about 33% from the confused demented old people I mentioned, 33% from people having minor procedures performed without anaesthetics for one or another good reason, and 33% from people who just have very painful diseases (plus 1% from me sitting in the break room looking up examples of hospital poetry for this post). They run the gamut of human screams. There are wordless shrieks. There are some angry screams, like “$#%! YOU GET ME OUT OF HERE!”. There are a lot of people screaming “SOMEBODY HELP ME!” And there are some religious screams, like “OH GOD!” or “JESUS HELP ME!” or “CHRIST NO!”. When I first started working in hospitals, I would not only inevitably run over to these screams, but I would feel contempt and anger at the rest of the hospital staff who would just continue their daily routine. I soon learned better. Not only would I be unable to do anything – I can’t single-handedly cure their painful illness, or make their procedure go any faster, or explain to them that the year is 2013 and they’re no longer on their childhood farm in Oklahoma – but as soon as they saw me I would be the one they started screaming at and expecting to save them. The bystander effect, my last defense, disappeared. Sometimes I would make a stand by asking the nurse to increase their pain medication or something, and be politely told all the reasons why that was a bad idea from a medical perspective (pain medication has lots of side effects which doctors monitor carefully). In the end I would just slink out of the room, wishing I had never come in. So the constant screams being completely ignored by a bunch of happy people going through their day is pretty hellish. But there’s also the bodies. Usually we are able to avoid thinking about people as bodies except to briefly note that certain people like Emma Watson are really hot. In a hospital, this filter disappears. Some people have gigantic swollen legs the size of your waist. Others have huge ulcerated sores all over. Still others have skin covered with the sorts of bacterial colonies you usually only see on a petri dish. And body sizes range from so thin that you can see their organs bulging out of their skin and use them as a grisly impromptu anatomy lesson, to so morbidly obese that you have to search through the fat folds to find body part you’re looking for. The senses are under constant assault. Smell is the worst. There are some people who can identify different infections by smell. Pseudomonas aeruginosa is supposed to smell fruity.Gardnerella is supposed to smell fishy. Clostridium is supposed to smell like the worst thing you can possibly imagine, if it were then covered in feces and left to rot on a warm summer day. But the other senses get their time too. The sight is vexed by flashing call lights. And the hearing is battered with incessant beeping from IV lines which have hard-coded alarms to alert doctors of critically important events such as “Look at me! I am an IV line!” The end result is something it would take a first-rate poet to describe. I’m tempted to nominate Oscar Wilde. He did a good job on prisons in Ballad of Reading Gaol, and I feel like the skill would transfer: He does not rise in piteous haste To put on convict-clothes, While some coarse-mouthed doctor gloats, and notes each new and nerve-twitched pose, Fingering a watch whose little ticks Are like horrible hammer-blows … He does not stare upon the air Through a little roof of glass; He does not pray with lips of clay For his agony to pass; Nor feel upon his shuddering cheek The kiss of Caiaphas. But after some more thought, I think I’m going to go with Wilfred Owen: If in some smothering dreams you too could pace Behind the wagon that we flung him in, And watch the white eyes writhing in his face, His hanging face, like a devil’s sack of sin; If you could hear, at every jolt, the blood Come gargling from the froth-corrupted lungs, Obscene as cancer, bitter as the cud Of vile, incurable sores on innocent tongues … Or better yet, if Oscar Wilde’s muse when he was writing Reading Gaol were to bear Wilfred Owen’s children, then those kids would be competent to write hospital poetry that was actually hospital poetry. Dante would also be an acceptable choice. III. You may have read the excellent article How Doctors Die. If you haven’t, do it now. It says that most doctors, knowing everything I’ve just mentioned above, choose to die quickly and with very limited engagement with the health system. I (and the doctors in my family whom I’ve asked) am pretty much like the doctors in the article. If I get a terminal disease, I want to wring what I can out of the few months of life I have left and totally avoid any surgery, chemotherapy, amputations, ventilators, and the like. It would be a clean death. It would be okay. My big fear, though, is that I won’t get a terminal disease. If I just start accumulating damage, growing more and more bedridden and demented and pain-riddling until I want out – well, there won’t be a way out. If there’s not some very specific life-saving treatment that can be withdrawn, I’m stuck above ground, not just in the “unless I want to risk the danger and shame of suicide” way I am now, but – if I’m too debilitated to access means of suicide on my own – in an absolute way. Even if my doctors and nurses and caretakers are sympathetic, my only legal option, without exposing them to jail time, is to starve myself to death – something both painful and difficult, and itself not really the way I want to go. I was sitting in an ICU room yesterday where a patient’s body had just been brought out after their death. My attending was taking care of the paperwork in the other room, and I was sitting there reflecting, and I started thinking about what it would be like to die in that room. There was a big window, and it was a sunny day, and although I mostly had a spectacular view of the hospital parking lot, a bit further in the distance I could see a park full of really big trees. And I knew that if I were dying in that room my last thought would be that I wanted to be outside. I think if I were very debilitated and knew I would die soon, I would want to go to that park or one like it on a very sunny day, surround myself with my friends and family, say some last words, and give myself an injection of potassium chloride. (this originally read “morphine”, but just today the palliative care doctor at my hospital gave an impassioned lecture about how people need to stop auto-associating morphine with euthanasia, because it makes it really hard for him to offer morphine painkillers to patients who need them without them freaking out. So potassium chloride it is.) This will never happen. Or if it did, it would be some kind of huge scandal, and whoever gave me the potassium chloride would be fired or something. But the people dying demented and hopeless connected to half a dozen tubes in ICU rooms aren’t considered scandals by anybody. That’s just “the natural way of things”. I work in a Catholic hospital. People here say the phrase “culture of life” a lot, as in “we need to cultivate a culture of life.” They say it almost as often as they say “patient-centered”. At my hospital orientation, a whole bunch of nuns and executives and people like that got up and told us how we had to do our part to “cultivate a culture of life.” And now every time I hear that phrase I want to scream. 21st century American hospitals do not need to “cultivate a culture of life”. We have enough life. We have life up the wazoo. We have more life than we know what to do with. We have life far beyond the point where it becomes a sick caricature of itself. We prolong life until it becomes a sickness, an abomination, a miserable and pathetic flight from death that saps out and mocks everything that made life desirable in the first place. 21st century American hospitals need to cultivate a culture of life the same way that Newcastle needs to cultivate a culture of coal, the same way a man who is burning to death needs to cultivate a culture of fire. And so every time I hear that phrase I want to scream, or if I cannot scream, to find some book of hospital poetry that really is a book of hospital poetry and shove it at them, make them read it until they understand. There is no such book, so I hope it will be acceptable if I just rip off of Wilfred Owen directly: If in some smothering dreams you too could pace Behind the gurney that we flung him in, And watch the white eyes writhing in his face, His hanging face, like a devil’s sack of sin; If you could hear, at every jolt, the blood Come gargling from the froth-corrupted lungs, Obscene with cancer, bitter with the cud Of vile, incurable sores on innocent tongues My friend, you would not so pontificate To reasoners beset by moral strife The old lie: we must try to cultivate A culture of life.